Radioiodtherapie bei benignen Schilddrüsenerkrankungen (Version 5)^*

Zusammenfassung

Die Version 5 der Leitlinie zur Radioiodtherapie bei benignen Schilddrüsenerkrankungen ist ein Update der Version 4, die im Jahr 2007 durch die Deutsche Gesellschaft für Nuklearmedizin (DGN) in Abstimmung mit der Deutschen Gesellschaft für Endokrinologie (DGE, Sektion Schilddrüse) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) publiziert worden war. Die Leitlinie ist mit den Empfehlungen der European Association of Nuclear Medicine (EANM) harmonisiert worden. Nach der „Richtlinie Strahlenschutz in der Medizin“ ist die „rechtfertigende Indikation“ zur Radioiodtherapie durch einen fachkundigen Arzt („Fachkunde in der Therapie mit offenen radioaktiven Stoffen“) zu stellen. Daher werden Indikationen zur Radioiodtherapie und alternative Behandlungsmöglichkeiten in dieser Leitlinie diskutiert. Die Leitlinie wurde von einer repräsentativen Expertengruppe im informellen Konsens verabschiedet und entspricht damit einer Verfahrensanweisung der ersten Stufe (S1) nach den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF).

Summary

The version 5 of the guideline for radioiodine therapy of benign thyroid disorders is an update of the version 4, which was published by the German Society of Nuclear Medicine (Deutsche Gesellschaft für Nuklearmedizin, DGN) in co-ordination with the German Society of Endocrinology (Deutsche Gesellschaft für Endokrinologie, DGE, Sektion Schilddrüse) and the German Society of General- and Visceral-Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) in 2007. This guideline was harmonized with the recommendations of the European Association of Nuclear Medicine (EANM). According to the German “Directive on Radiation Protection in Medicine” the physician specialised in nuclear medicine („Fachkunde in der Therapie mit offenen radioaktiven Stoffen”) is responsible for the justfication to treat with radioiodine. Therefore, relevant medical indications for radioiodine therapy and alternative therapeutic options are discussed within the guideline. This procedure guideline is developed in the consensus of a representative expert group. This fulfils the level S1 (first step) within the German classification of Clinical Practice Guidelines.

Schlüsselwörter

Leitlinie - Radioiodtherapie - Schilddrüsenüberfunktion - Morbus Basedow - Autonomie - Struma

Keywords

Guideline - radioiodine therapy - hyperthyroidism - thyrotoxicosis - Graves’ disease - toxic goiter

^* Stand 10/2015 – AWMF-Registrierungsnummer: 031 – 003; Herausgeber: Deutsche Gesellschaft für Nuklearmedizin, Nikolaistr. 29, 37073 Göttingen; weitere Beteiligte: Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e. V. (DGAV), Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK) der DGAV, Deutsche Gesellschaft für Chirurgie e. V. (DGCH), Deutsche Gesellschaft für Endokrinologie e. V. (DGE), Sektion Schilddrüse der DGE

• Literatur

• 1 Bachmann J, Kobe C, Bor S. et al. Radioiodine therapy for thyroid volume reduction of large goitres. Nucl Med Commun 2009; 30: 466-471.
• 2 Bahn RS, Burch HB, Cooper DS. et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21: 593-641.
• 3 Bartalena L, Marcocci C, Bogazzi F. et al. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med 1998; 338: 73-78.
• 4 Bartalena L, Baldeschi L, Dickinson A. et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 2008; 158: 273-285.
• 5 Bonnema SJ, Bennedbaek FN, Veje A. et al. Propylthiouracil before I-131 therapy of hyperthyroid diseases; effect on cure rate evaluated by a randomized clinical trial. J Clin Endocrinol Metab 2004; 89: 4439-4444
• 6 Bonnema SJ, Nielsen VE, Boel-Jørgensen H. et al. Improvement of goiter volume reduction after 0.3 mg recombinant human thyrotropin-stimulated radioiodine therapy in patients with a very large goiter: a double-blinded, randomized trial. J Clin Endocrinol Metab 2007; 92: 3424-3434.
• 7 Cappelen T, Unhjem JF, Amundsen AL. et al. Radiation exposure to family members of patients with thyrotoxicosis treated with iodine-131. Eur J Nucl Med 2006; 33: 81-86.
• 8 Ceccarelli C, Bencivelli W, Vitti P. et al. Outcome of radioiodine-131 therapy in hyperfunctioning thyroid nodules: a 20 years’ retrospective study. Clin Endocrinol (Oxf) 2005; 62: 331-335.
• 9 Chao M, Jiawei X, Guoming W. et al. Radioiodine treatment for pediatric hyperthyroid Graves’ disease. Eur J Pediatr 2009; 168: 1165-1169.
• 10 Chen DY, Jing J, Schneider PF, Chen TH. Comparison of the long-term efficacy of low-dose ¹³¹I versus antithyroid drugs in the treatment of hyperthyroidism. Nucl Med Commun 2009; 30: 160-168.
• 11 Chen DY, Schneider PF, Zhang XS. et al. Striving for euthyroidism in radioiodine therapy of Graves’ disease: a 12-year prospective, randomized, open-label blinded end point study. Thyroid 2011; 21: 647-654.
• 12 Chen DY, Schneider PF, Zhang XS. et al. Changes in Graves’ ophthalmopathy after radioiodine and anti-thyroid drug treatment of Graves’ disease from 2 prospective, randomized, open-label, blinded end point studies. Exp Clin Endocrinol Diabetes 2014; 122: 1-6.
• 13 Cooper DS, Doherty GM, Haugen BR. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-1214.
• 14 Dederichs B, Dietlein M, Jenniches-Kloth B. et al. Radioiodine therapy of Graves’ hyperthyroidism in patients without pre-existing ophthalmopathy: can glucocorticoids prevent the development of new ophthalmopathy?. Exp Clin Endocrinol Diabetes 2006; 115: 366-370.
• 15 Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie. Operative Therapie benigner Schilddrüsenerkrankungen. AWMF-Leitlinien-Register Nr. 003/002, letzte Aktualisierung. 2010 www.awmf.de/leitlinien/detail/II/003-002.html
• 16 Dietlein M, Dederichs B, Kobe C. et al. Therapy for non-toxic multinodular goiter: radioiodine therapy as attractive alternative to surgery. Nuklearmedizin 2006; 45: 21-34.
• 17 Dietlein M, Eschner W, Lassmann M. et al. DGN-Handlungsempfehlung (S1-Leitlinie): Radioiodtest (Version 4). Stand 10/2014 - AWMF-Registernummer: 031-012
• 18 Dietlein M, Eschner W, Lassmann H. et al. DGN-Handlungsempfehlung (S1-Leitlinie): Schilddrüsenszintigraphie (Version 4). Stand 10/2014 - AWMF-Registernummer: 031-011
• 19 Dralle H, Sekulla C. Morbidität nach subtotaler und totaler Thyreoidektomie beim Morbus Basedow: Entscheidungsgrundlage für Operationsindikation und Resektionsausmaß. Z Ärztl Fortbild Qual Gesundh 2004; 98 (Suppl V) 45-53.
• 20 Dunkelmann S, Endlicher D, Prillwitz A. et al. Ergebnisse der TcTUs-optimierten Radioiodtherapie bei multifokaler und disseminierter Autonomie. Nuklearmedizin 1999; 38: 131-139.
• 21 Dunkelmann S, Wolf R, Koch A. et al. Incidence of radiation-induced Graves’ disease in patients treated with radioiodine for thyroid autonomy before and after introduction of a high-sensitivity TSH receptor antibody assay. Eur J Nucl Med 2004; 31: 1428-1434.
• 22 Dunkelmann S, Neumann V, Staub U. et al. Ergebnisse einer risikoadaptierten und funktionsorientierten Radioiodtherapie bei Morbus Basedow. Nuklearmedizin 2005; 44: 238-242.
• 23 Dunkelmann S, Kuenster H, Nabavi E. et al. Change in the intrathyroidal kinetics of radioiodine under continued and discontinued antithyroid medication in Graves’ disease. Eur J Nucl Med Mol Imaging 2007; 34: 228-236.
• 24 Eckstein AE, Plicht M, Lex H. et al. Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 2006; 91: 3464-3470.
• 25 Fast S, Nielsen VE, Grupe P. et al. Optimizing ¹³¹I uptake after rhTSH stimulation in patients with nontoxic multinodular goiter: evidence from a prospective, randomized, double-blind study. J Nucl Med 2009; 50: 732-737.
• 26 Fast S, Hegedüs L, Pacini F. et al. Long-term efficacy of modified release recombinant human thyrotropin augmented radioiodine therapy for begnin multinodular goiter: results from a multicenter, international, randomized, placebo-controlled, dose-selection study. Thyroid 2014; 24: 727-735.
• 27 Holm LE, Lundell G, Israelsson A, Dahlqvist I. Incidence of hypothyroidism occurring long after iodine-131 therapy for hyperthyroidism. J Nucl Med 1982; 23: 103-107.
• 28 International Commission on Radiological Protection. Release of patients after therapy with unsealed radionuclides. Ann ICRP 2004; 34: 1-79 Erratum in: Ann ICRP 2004; 34: 281. Ann ICRP 2006; 36: 77.
• 29 Jensen BE, Bonnema SJ, Hegedues L. Glucocorticoids do not influence the effect of radioiodine therapy in Graves’ disease. Eur J Endocrinol 2005; 153: 15-21.
• 30 Kahaly GJ, Bartalena L, Hegedüs L. The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective. Thyroid 2008; 21: 585-591.
• 31 Kahraman D, Keller C, Schneider C. et al. Development of hypothyroidism in long-term follow-up in patients with toxic goiter after radioiodine therapy. Clin Endocrinol 2012; 76: 297-303.
• 32 Kobe C, Eschner W, Sudbrock F. et al. Graves’ disease and radioidine therapy: Is success of ablation dependent on the achieved dose above 200 Gy?. Nuklearmedizin 2008; 47: 13-17.
• 33 Kobe C, Weber I, Eschner W. et al. Graves’ disease and radioiodine therapy: is success of ablation dependent on the choice of thyreostatic medication?. Nuklearmedizin 2008; 47: 153-166.
• 34 Kobe C, Eschner W, Wild M. et al. Radioiodine therapy of benign thyroid disorders: what are the effective thyroidal half-life and uptake of ¹³¹I?. Nucl Med Commun 2010; 31: 201-205.
• 35 Kubota S, Ohye H, Yano G. et al. Two-day thioamide withdrawal prior to radioiodine uptake sufficiently increases uptake and does not exacerbate hyperthyroidism compared to 7-day withdrawal in Graves’ disease. Endocrine J 2006; 53: 603-607.
• 36 Lai A, Sassi L, Compri E. et al. Lower dose prednisone prevents radioiodine-associated exacerbation of initially mild or absent Graves’ orbitopathy: a retrospective cohort study. J Clin Endocrinol Metab 2010; 95: 1333-1337.
• 37 Lantz M, Planck T, Asman P, Hallengren B. Increased TRAb and/or low anti-TPO titers at diagnosis of Graves’ disease are associated with an increased risk of developing ophthalmopathy after onset. Exp Clin Endocrinol Diabetes 2014; 122: 113-117.
• 38 Lee YY, Tam KW, Lin YM. et al. Recombinant human thyrotropin before iodine-131 therapy in patients with nodular goiter: a meta-analysis of randomized controlled trials. Clin Endocrinol (Oxf) 2015; 83: 702-710.
• 39 Ma C, Kuang A, Xie J, Liu GJ. Radioiodine for pediatric Graves’ disease. John Wiley & Sons, Ltd, 2009. Cochrane Database of Systematic Reviews. 2008 Issue 3. Art. No.: CD006294.
• 40 Nielsen VE, Bonnema SJ, Boel-Jorgensen H. et al. Stimulation with 0.3 mg recombinant human thyrotropin prior to iodine 131 therapy to improve the size reduction of benign non-toxic nodular goiter: a prospective randomized double-blind trial. Arch Intern Med 2006; 166: 1476-1482.
• 41 Nieuwlaat WA, Huysmans DA, van den Bosch HC. et al. Pretreatment with a single, low dose of recombinant human thyrotropin allows dose reduction of radioiodine therapy in patients with nodular goiter. J Clin Endocrinol Metab 2003; 88: 3121-3129.
• 42 Nimmons GL, Funk GF, Graham MM, Pagedar NA. Urinary iodine excretion after contrast computed tomography scan: implications for radioactive iodine use. JAMA Otolaryngol Head Neck Surg 2013; 139: 479-482.
• 43 Nwatsock JF, Taieb D, Tessonnier L. et al. Radioiodine thyroid ablation in Graves’ hyperthyroidism: merits and pitfalls. World J Nucl Med 2012; 11: 7-11.
• 44 Perros P, Kendall-Taylor P, Neoh C. et al. A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active Graves’ ophthalmopathy. J Clin Endocrinol Metab 2005; 90: 5321-5323.
• 45 Reinhardt MJ, Joe A, von Mallek D. et al. Dose selection for radioiodine therapy of borderline hyperthyroid patients with multifocal and disseminated autonomy on the basis of ^99mTc-pertechnetate thyroid uptake. Eur J Nucl Med 2002; 29: 480-485.
• 46 Reinhardt MJ, Brink I, Joe AY. et al. Radioiodine therapy in Graves’ disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome. Eur J Nucl Med 2002; 29: 1118-1124.
• 47 Reinhardt M, Kim B, Wissmeyer M. et al. Dose selection for radioiodine therapy of borderline hyperthyroid patients according to thyroid uptake of ^99mTc-pertechnetate: applicability to unifocal thyroid autonomy?. Eur J Nucl Med 2006; 33: 608-612.
• 48 Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves’ disease is radioiodine. J Clin Endocrinol Metab 2007; 92: 797-800.
• 49 Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics 2003; 111: 745-749.
• 50 Rokni H, Sadeghi R, Moossavi Z. et al. Efficacy of different protocols of radioiodine therapy for treatment of toxic nodular goiter: systematic review and meta-analysis of the literature. Int J Endocrinol Metab 2014; 12: e14424.
• 51 Santos RB, Romaldini JH, Ward LS. Propylthiouracil reduces the effectiveness of radioiodine treatment in hyperthyroid patients with Graves’ disease. Thyroid 2004; 14: 525-530.
• 52 Schicha H, Reiners C, Moser E, Schober O. Subclinical thyroid disease. Nuklearmedizin 2004; 43: 69-71.
• 53 Schmidt M, Gorbauch E, Dietlein M. et al. Incidence of post-radioiodine immunogenic hyperthyroidism / Graves’ disease in relation to a temporary increase in TSH-receptor antibodies after radioiodine therapy for autonomous thyroid disease. Thyroid 2006; 16: 281-288.
• 54 Selmer C, Olesen JB, Hansen ML. et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. Br Med J 2012; 345: e7895.
• 55 Selmer C, Olesen JB, Hansen ML. et al. Subclinical and ouvert thyroid dysfunction and risk of all-cause mortality and cardiovascular events: a large population study. J Clin Endocrinol Metab 2014; 99: 2372-2382.
• 56 Shiber S, Stiebel-Kalish H, Shimon I. et al. Glucocorticoid regimens for prevention of Graves’ ophthalmopathy progression following radioiodine treatment: systematic review and meta-analysis. Thyroid 2014; 24: 1515-1523.
• 57 Silberstein EB, Alavi A, Balon HR. et al. The SNMMI practice guideline for therapy of thyroid disease with ¹³¹I 3.0. J Nucl Med 2012; 53: 1633-1651.
• 58 Silva MN, Rubió IG, Romão R. et al. Administration of a single dose of recombinant human thyrotrophin enhances the efficacy of radioiodine treatment of large compressive multinodular goiters. Clin Endocrinol (Oxf) 2004; 60: 300-308.
• 59 Stan MN, Durski JM, Brito JP. et al. Cohort study on radioactive iodine-induced hypothyroidism: implications for Graves’ ophthalmopathy and optimal timing for thyroid hormone assessment. Thyroid 2013; 23: 620-625.
• 60 Stokkel MPM, Handkiewicz Junak D, Lassmann M. et al. EANM procedure guidelines for therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging 2010; 37: 2218-2228.
• 61 Strahlenschutz in der Medizin - Richtlinie zur Verordnung über den Schutz vor Schäden durch ionisierende Strahlen (Strahlenschutzverordnung - StrlSchV). Gemeinsames Ministerialblatt. 2011 S. 867
• 62 Strahlenschutzkommission (SSK) des Bundesministeriums für Umwelt, Naturschutz und Reaktorsicherheit. Ambulante, fraktionierte Radioiodtherapie. Empfehlung der Strahlenschutzkommission vom 22./23. Februar 1996 Bundesanzeiger Nr. 132 (18.7.1996)
• 63 Strahlenschutzkommission (SSK) des Bundesministeriums für Umwelt, Naturschutz und Reaktorsicherheit. Strahlenschutzgrundsätze für die Radioiodtherapie. Empfehlung der Strahlenschutzkommission vom 5./6. Dezember 1996 Bundesanzeiger Nr. 68 (11.4.1997)
• 64 Strahlenschutzkommission (SSK) des Bundesministeriums für Umwelt, Naturschutz und Reaktorsicherheit. Nachsorge für Patienten nach Strahlenbehandlung. Empfehlung der Strahlenschutzkommission vom 11./12. Februar 1998 Bundesanzeiger Nr. 114 (6.8.1998)
• 65 Strahlenschutzverordnung. Textausgabe mit einer erläuternden Einführung von Hans-Michael Veith. 8. Aufl.. Köln: Bundesanzeiger-Verlag; 2010
• 66 Sung JY, Baek JH, Jung SL. et al. Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid 2015; 25: 112-117.
• 67 Vannucchi G, Campi I, Covelli D. et al. Graves’ orbitopathy activation after radioactive iodine therapy with and without steroid prophylaxis. J Clin Endocrinol Metab 2009; 94: 3381-3386.
• 68 Vogt H, Wengenmair H, Kopp J. et al. Radioiodine therapy for combined disseminated and nodular thyroid autonomy. Nuklearmedizin 2006; 45: 101-104.
• 69 Walter MA, Crist-Crain M, Schindler C, Mueller-Brand J, Mueller B. Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison. Eur J Nucl Med 2006; 33: 730-737.
• 70 Wesche MF, Tiel-V Buul MM, Lips P, Smits NJ, Wiersinga WM. A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter. J Clin Endocrinol Metab 2001; 86: 998-1005.
• 71 Willegaignon J, Sapienza MT, Buchpiguel CA. Radioiodine therapy for Graves disease: thyroid absorbed dose of 300 Gy - tuning the target for therapy planning. Clin Nucl Med 2013; 38: 231-236.
• 72 Zang S, Ponto KA, Kahaly G. Intravenous glucocorticoids for Graves’ orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab 2011; 96: 320-332.